Genesis Family Recovery Coaching Scholarship Application

About our organization:

Recovery Coaching services at Genesis Family involve a client-centred approach, where the particular needs of each individual and family are addressed through specific treatment goals and plans. All of our Recovery coaches are Certified through the International Association of Professional Recovery Coaches (IARPC). All our coaches operate all from a biblically-based worldview. While Genesis Family is a Christcentred organization, we do not require our clients to subscribe to the same faith or values. Therefore, individuals from all faiths, cultures, and walks of life are welcome.

The Genesis Family Scholarship:

Our private operating foundation, Genesis Family, has as one of its goals providing Recovery Coaching scholarships for people who are battling with an addiction but cannot afford it. We generate these finances by asking other organizations or individuals to donate to our 501(c)3 foundation. In other cases, the Genesis Family Foundation LLC can also provide scholarships itself if financially possible. Please send a completed form with handwritten signature to info@genesis-family.com.

Contact Us

Name:

Email:

Phone:

I am applying on behalf of: (the person needing Recovery coaching)

Myself

My partner/spouse

My child

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Contact information of person you are applying for (if not for yourself):

Name:

Email:

Phone Number:

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Please note: A separate application must be made for each individual requiring Recovery Coaching services.

Presenting Problem: (why are you seeking recovery/life/relationship coaching?)

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Declaration:

I declare that I am financially unable to pay for Recovery coaching services at Genesis Family Foundation LLC ($85 or more). The issue described above is too severe that I cannot wait to acquire the sufficient funds. I give permission to the Genesis Family Private Operating Foundation to share my presenting problem, WITHOUT sharing personal data, to potential donors/sponsors that might be willing to pay for my Recovery coaching.

I give Genesis Family permission to reach out to third parties whom are known (potential) sponsors with a message requesting funds on my behalf.

Please note: Genesis Family Inc. will never identify you, share your contact information or any other personal health information with third parties.

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Financial information (on which to prove financial inability to cover recovery coaching expenses):

Basic monthly net income:

Basic monthly household expenses:

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Please note: When scholarship is offered, we require a copy of 2 recent pay stubs of the client and/or client’s sponsor(s) before the scholarship is confirmed.

I declare that all information I have provided on this application is correct and true to the best of my knowledge.

(if 16 years or older, consent of client him/herself is required by Texas law.)

Name of applicant:

Date:

Electronic Signature:

Name of client:

Date:

Electronic Signature:

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